Hemodynamic instability is generally considered as a contraindication to liver splitting, in particular when using an in situ technique. We describe the cases of two young donors with brain death in whom refractory cardiac arrest and hemodynamic instability were supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), allowing uneventful in situ splitting. Two adult and two pediatric liver recipients were successfully transplanted with immediate graft function. Favorable outcomes were also observed for the other transplanted organs, including one heart, two lungs, and four kidneys. Refractory cardiac arrest and hemodynamic instability corrected by VA-ECMO should not be considered as a contraindication to in situ liver splitting.
Keywords: clinical research/practice; donors and donation: donation after brain death (DBD); donors and donation: extended criteria; editorial/personal viewpoint; extracorporeal membrane oxygenation (ECMO); iver transplantation/hepatology; liver transplantation: split; organ procurement; organ procurement and allocation.
© 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.